Optimizing the diagnosis and treatment of migraine.

PURPOSE: To describe and discuss short headache questionnaires, which can simplify and improve the diagnosis of migraine. DATA SOURCES: Review of the worldwide scientific literature on short diagnostic questionnaires for migraine. CONCLUSIONS: A new three-question Headache Screen addressing disability due to recurring headaches, headache duration, and changes in headache characteristics and/or pattern over the previous 6 months displayed high sensitivity when used to survey >3000 migraineurs, correctly identifying 77% of migraineurs diagnosed by International Headache Society (IHS) criteria, clinical impression, or the presence of recurring, disabling headaches. IMPLICATIONS FOR PRACTICE: The underdiagnosis and undertreatment of migraine are problems that may be attributed to many causes involving both patients and medical providers. These include stringent diagnostic criteria established by the IHS, which fail to easily classify many common migraine presentations, the lack of clear outcome measures of successful management of migraine, and failure to recognize the iatrogenic role of prescription and nonprescription medications as an etiologic factor in chronic daily headache. The recent development of reliable, clinically useful, short headache questionnaires that are focused on headache impact facilitates the understanding and diagnosis of migraine for both patients and healthcare professionals. As a diagnostic tool, the Headache Screen has the potential to expand appropriate medication use, leading to improved functional status and quality of life for migraineurs.

Assessment of sleepiness and unintended sleep in Parkinson's disease patients taking dopamine agonists.

OBJECTIVE: We sought to determine if patients with Parkinson's disease (PD), taking dopamine agonists (DAs) and reporting unintended sleep episodes (SEs), exhibit physiologically defined daytime sleepiness and can thus be differentiated from those taking DAs but not reporting SEs. METHODS: Twenty-four patients with abnormal Epworth Sleepiness Scale scores of >10 who were taking DAs were enrolled into one of two groups: those with SEs (SE+, n=16) and those without (SE-, n=8). Three consecutive days of testing included two nights of polysomnography followed by the Multiple Sleep Latency Test (MSLT). RESULTS: Overall frequency of pathological sleepiness (MSLT <5 min) was 42% (10/24). Mean levels of sleepiness, frequencies of pathological sleepiness, and naps with stage 2 or REM-sleep were similar between SE+ and SE- groups. Sleep tendency was similar in patients prescribed pergolide, ropinirole, and pramipexole combined with levodopa. Polysomnography testing revealed no significant differences between the groups in total sleep time, sleep efficiency, sleep architecture, or presence of restless legs syndrome or periodic leg movements. There was no relation between degree of nocturnal sleep disturbance and level of daytime sleepiness. CONCLUSIONS: The results of this study suggest SEs in PD patients occur upon a background of excessive daytime sleepiness and are unrelated to nocturnal sleep or use of a specific DA.

Simple and efficient recognition of migraine with 3-question headache screen.

OBJECTIVE: To correlate the results of a new 3-question headache screen to 3 established methods of diagnosing migraine: the International Headache Society diagnostic criteria, physician's clinical impression, and presence of recurring disabling headaches. BACKGROUND: A simple tool to recognize patients who experience migraine may facilitate diagnosis of this debilitating and frequently undiagnosed condition. METHODS: Primary care physicians and neurologists in the United States enrolled 3014 adults with a diagnosis of migraine based on one of the following: International Headache Society criteria, an investigator's clinical impression, or presence of recurring disabling headaches. Each patient completed a 3-question headache screen: (1) Do you have recurrent headaches that interfere with work, family, or social functions? (2) Do your headaches last at least 4 hours? (3) Have you had new or different headaches in the past 6 months? A diagnosis of migraine was suggested by a yes answer to questions 1 and 2 and a no answer to question 3. RESULTS: The 3-question headache screen identified migraine in 77% of the study population; including 78% of the patients enrolled based on International Headache Society criteria, 74% based on clinical impression, and 68% because of recurring disabling headaches. CONCLUSIONS: Positive 3-question headache screen results agreed well with migraine diagnoses based on International Headache Society criteria, clinical impressions, and presence of recurring disabling headaches. These findings support use of the 3-question headache screen to recognize migraine.